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Overview of foodborne illness (E. coli and Campylobacter)

Widespread, deadly, and underreported

Foodborne pathogens are common and opportunistic; they disproportionately affect
children, the elderly, and immunocompromised individuals.

Despite a sophisticated nationwide surveillance and reporting network, it is difficult
to draw an accurate picture of foodborne illness in the United States. In 2006 there
were 1,270 foodborne disease outbreaks, resulting in a reported 27,634 cases and
11 deaths.1 And the CDC admits these numbers may not be complete and
accurate. “The number of reported cases of diseases under surveillance is a vast
underestimate of the true burden, because most episodes of disease never reach the
reporting system.”2

The World Health Organization estimates that in 2005, 1.8 million people worldwide
died from diarrheal diseases. The majority are foodborne. Many children in developing
countries suffer from malnutrition as a consequence of diarrheal disease.3

E. coli pathogenesis

E. coli bacteria are natural inhabitants of the human body, colonizing the
digestive tracts of neonates within hours of birth.4 The bacteria enjoy
a symbiotic relationship with their hosts. Highly adaptable, E. coli can
thrive in anaerobic and aerobic environments, sense chemical and temperature changes,
and grow fimbriae to attach to mucosal surfaces.5

There are more than 700 known E. coli serotypes, which are characterized
by their expression of O, H, and K antigens.4 Pathogenic E. coli
are diarrheagenic and fall into distinct categories according to their mechanism
of pathogenesis.4 Recent E. coli outbreaks have been traced to
ground beef, leafy vegetables (including spinach), packaged cookie dough, and pizza.

Enterohemorrhagic E. coli (EHEC)

Enterohemorrhagic E. coli, so named because they cause bloody diarrhea, are
found in humans, cattle, and goats. Some serotypes can produce Shiga toxins (STx)
and are referred to as Shiga toxigenic E. coli (STEC). STEC are associated
with significant morbidity and mortality. The STEC serotype O157:H7 has been isolated
in many outbreaks.4 However there is growing concern over non-O157 Shiga
toxin producing E. coli, which now cause about 50% of all STEC infections.6,7

Hemolytic uremic syndrome (HUS) in about 5% to 8% of pediatric patients with hemorrhagic
colitis8

HUS is characterized by acute renal failure

HUS is potentially fatal

HUS can result in permanently compromised kidney function

According to the CDC, of 3,464 patients with STEC infection9:

42% were hospitalized

6.3% suffered hemolytic uremic syndrome (HUS)

0.6% died (5% mortality rate for HUS patients)9

Campylobacter pathogenesis

Campylobacter is the leading bacterial cause of gastroenteritis (often called
“stomach flu”) and diarrhea in the developed world.10,11Campylobacter
accounts for 5% to 7% of all cases of gastroenteritis in the U.S.12

Two species of Campylobacter, C. jejuni and C. coli, are common
human pathogens. C. jejuni is the most common isolate and there is evidence
to suggest that the species might take different routes to infection depending on
ethnicity, type of food eaten, and travel destinations.13

Campylobacter infection is sporadic and not driven by outbreak. About 50%
of the cases are attributable to handling and eating poultry.10 The infection
is substantially underreported; the CDC estimates that campylobacterosis
affects 2.4 million Americans each year including an estimated 124 deaths.11

Campylobacter infection (campylobacterosis)

Campylobacter produces two toxins14:

Enterotoxins which disturb water regulation in the GI tract and cause diarrhea

Cytoxins closely related to Shiga toxin, which are letal to epithelial cells in
the gut and can activate inflammatory mediators 14,15

In addition to diarrhea, symptoms of campylobacterosis include:

Bloody diarrhea (usually occult)

Abdominal pain

Nausea

Fever

Headache

Muscle pain16

While the majority of cases resolve without intervention in two to five days,11Campylobacter can cause serious and long-term consequences, including11:

Bacteremia (attributable primarily to C. fetus)12

Gullain-Barre Syndrome (an autoimmune inflammatory disease affection the peripheral
nervous system) in about 1 out of every 1,000 cases of campylobacterosis11